Sleep and Blood Sugar in Type 1 Diabetes
You went to bed at 112. Flat arrow. No active insulin. Textbook. You should be proud. You wake up at 218. So you run the checklist, check the site, question the insulin, replay every meal from the day before. And you come up empty. Here's...
The episode, word for word
I'm going to read you a list. See how many of these you recognize.
The pump site. The insulin being expired. What you ate 6 hours ago. Not drinking enough water. Too much water. The stress from that zoom call. The fact that I didn't sleep well. The weather, somehow. Lebron James flopping in the playoffs but you still love him. My general vibes being off.
That is an actual, real list of things I have personally blamed for blood sugars that didn't make sense. Over 34 years. I am a professional. Blah blah blah, whatever.
But there's one thing I kept leaving off that list. And it was right there the whole time.
My name is Neil Greathouse, and this is Your Best T1D Year.
All right. End of Week 1. Welcome. If you're just finding this today, you can jump in right here, right now. We're in a sleep challenge, we're tracking sleep hours and morning blood sugars, and Monday I'm going to give you a specific number from the research that I think is going to reframe some of your data. You don't need to have been here from day one. You're caught up.
Today I want to talk about blame.
And I know you're thinking...who, me? Chill, bruv... Not in a heavy way. In a kind of affectionate, I've-been-there, we've-all-done-this, let's-look-at-this-together kind of way.
Because one of the unspoken hobbies of T1D management is what I call blood sugar archaeology. You wake up with a high blood sugar and we went to bed at a decent number aaaaaaaaaand you start digging. What did I eat. When did I bolus. Did the site absorb right. Did I exercise at the wrong time.
You're basically a Law & Order detective at 7am and the crime scene is your own body and you have been doing this for years, probably before your first cup of coffee.
And sometimes...just sometimes... you find the answer. The site was bad. The infusion set kinked. You overtreated a low at 2am and fell back asleep before you realized it.
But sometimes you come up empty. And that empty is a particular kind of frustrating, because it hints at either that you missed something you should have caught, or your body just decided to do this for no reason, or you did something wrong that you can't identify and therefore can't fix or McGyver your way out of.
Here's what I think is actually happening in a lot of those cases.
You were solving the right puzzle with the wrong set of clues. The clues you were looking at were all from the day before. The food, the activity, the stress, the boluses. And those things matter. But you were missing a variable that was operating in a completely separate category. A category that nobody put on the list.
Sleep isn't on the blood sugar checklist. It wasn't in the T1D management playbook any of us were handed. Nobody said "and by the way, how you sleep tonight is going to affect how your insulin works tomorrow." So we didn't account for it. And then we blamed everything else.
I blamed insulin for going bad more times than I can count. Held the vial up to the light. Threw away perfectly good insulin because I was convinced something had happened to it, when really I just hadn't slept more than five hours in three days.
I've blamed the bacon egg bites. No lie.... 34 years doing this and I blamed a bacon egg bite from Starbucks and I can't even pronounce gruyere.
OK. So. Here's where we are. Next Monday, I'm giving you a number. Specific number. From a specific study that looked at what one bad night of sleep does to insulin sensitivity in people with type 1 diabetes. One night. And the number is not subtle.
I want you to have a few days of your own data sitting next to it when it arrives. So keep tracking. And this weekend, I want you to do one thing.
Think about the most confusing blood sugar you've had in the last couple weeks. The one that made no sense. The one where you ran through the full checklist and still couldn't figure it out.
What time did you go to sleep the night before?
I'm not saying that's definitely the answer. I'm saying it might be a variable you haven't considered yet. And Monday, we'll talk about why that might actually be it.
You've been writing down all this week: sleep hours, morning blood sugar, how the insulin felt. Keep building.
And today: look back at the data you've collected. You've got a few days now. Does the morning after your worst night of sleep look different from the others? Don't force a conclusion. Just look.
We'll talk through what you're seeing on Monday.
Hey. I know this disease asks a lot of you. The blood sugar archaeology at 7am. The ludicrous feeling that you missed something. The quiet guilt of a number you can't explain.
You didn't miss something obvious. You were missing a variable that wasn't in the briefing.
Stick with me until Monday. I'll see you right here.
I'm proud of you. Nobody remembers easy. You're not doing a bad job...you're doing a difficult job.
This is the script as read on the mic, lightly tidied for reading. Education, not medical advice. Talk to your care team before you change anything about your insulin.